1
|
Stevens B, Bialek S, Zhao K, Maqusi S, Rassi EE, Tan J, Graffeo CS. Profound Pneumocephalus and Low-Pressure Hydrocephalus Triggered by Ventriculoperitoneal Shunt Placement after Resection, Fat Graft Reconstruction, and Radiotherapy for a Malignant Skull Base Schwannoma. J Neurol Surg Rep 2024; 85:e138-e143. [PMID: 39220674 PMCID: PMC11364467 DOI: 10.1055/a-2376-7197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2024] [Accepted: 07/25/2024] [Indexed: 09/04/2024] Open
Abstract
Background Tension pneumocephalus is a rare postoperative complication, typically presenting with mental status changes or rapid neurological decline after craniotomy. We report a complex case of tension pneumocephalus triggered by graft retraction after ventriculoperitoneal (VP) shunt placement. Case History A 39-year-old woman with a recurrent left trigeminal cavernous sinus schwannoma, status post one prior resection, two stereotactic radiosurgery treatments, and one course of fractionated radiotherapy, underwent radical resection with orbital exenteration and abdominal fat free graft reconstruction followed by adjuvant radiotherapy for malignant transformation. She developed subacute ventriculomegaly with altered mental status, prompting VP shunt placement. Three weeks later, she presented with profound pneumocephalus and intraventricular air originating from a large, left-sided sphenoid and maxillary defect, from which the fat graft had retracted. A right frontal external ventricular drain (EVD) was placed, resulting in immediate release of air under high pressure. Definitive treatment required skull base reconstruction with a latissimus dorsi free flap, contralateral nasoseptal flap, antibiotics, and VP shunt revision for treatment of combined cerebrospinal fluid (CSF) leak, pneumocephalus, ventriculitis, and low-pressure hydrocephalus. As of her last follow-up, she was restored to her initial postresection neurological baseline. Conclusion Tension pneumocephalus is a rare and life-threatening emergency that requires immediate neurosurgical intervention. We report the index case of tension pneumocephalus induced by graft retraction following radiotherapy and CSF diversion. Where observed, tension pneumocephalus resulting from a skull base CSF leak may be associated with low-pressure hydrocephalus, and successful long-term management demands balancing the need for CSF diversion against the integrity of the skull base reconstruction.
Collapse
Affiliation(s)
- Baylee Stevens
- Departments of Neurosurgery, University of Oklahoma, Oklahoma City, Oklahoma, United States
| | - Shannan Bialek
- Departments of Neurosurgery, University of Oklahoma, Oklahoma City, Oklahoma, United States
| | - Kyle Zhao
- Departments of Neurosurgery, University of Oklahoma, Oklahoma City, Oklahoma, United States
| | - Suhair Maqusi
- Departments of Plastic Surgery, University of Oklahoma, Oklahoma City, Oklahoma, United States
| | - Edward El Rassi
- Departments of Otolaryngology-Head and Neck Surgery, University of Oklahoma, Oklahoma City, Oklahoma, United States
| | - Jeremy Tan
- Dean McGee Eye Institute, Oklahoma City, Oklahoma, United States
| | - Christopher S. Graffeo
- Departments of Neurosurgery, University of Oklahoma, Oklahoma City, Oklahoma, United States
| |
Collapse
|
2
|
Chen PJ, Lin HL. Severe pneumocranium after gamma knife stereotactic radiosurgery for brain metastasis: A case report and literature review. Medicine (Baltimore) 2024; 103:e38464. [PMID: 38847695 PMCID: PMC11155530 DOI: 10.1097/md.0000000000038464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 05/15/2024] [Indexed: 06/10/2024] Open
Abstract
RATIONALE Gamma knife stereotactic radiosurgery (GKRS) is a recognized safe and effective treatment for brain metastasis; however, some complications can present significant clinical challenges. This case report highlights a rare occurrence of cerebrospinal fluid (CSF) leakage and pneumocranium following GKRS, emphasizing the need for awareness and prompt management of these complications. PATIENT CONCERNS A 35-year-old male with a history of malignant neoplasm of the lip in 2015 and perineural spread of malignancy into the left cavernous sinus was treated with GKRS in 2017. The patient was admitted emergently 39 days after discharge due to persistent headache and dizziness. DIAGNOSES Brain computed tomography (CT) revealed diffuse bilateral pneumocranium alongside an observation of CSF leakage. INTERVENTIONS A surgical procedure involving a left frontal-temporal craniotomy was performed to excise a residual skull base tumor and repair the dura, guided by a navigator system. The conclusive pathological assessment revealed the presence of squamous cell carcinoma markers. OUTCOMES The patient exhibited excellent tolerance to the entire procedure and experienced a prompt and uneventful recovery process. After surgery, the symptoms alleviated and CSF leak stopped. The follow-up image showed the pneumocranium resolved. LESSONS Pneumocranium due to early-stage post-GKRS is uncommon. The rapid tumor shrinkage and timing of brain metastasis spreading through the dura can lead to CSF leak and pneumocranium. We reviewed current treatment options and presented a successful craniotomy-based dura repair case.
Collapse
Affiliation(s)
- Paul J. Chen
- Department of Neurosurgery, China Medical University Hospital, Taichung City, Taiwan (R.O.C.)
| | - Hung-Lin Lin
- Department of Neurosurgery, China Medical University Hospital, Taichung City, Taiwan (R.O.C.)
| |
Collapse
|
3
|
Jumah A, Alsaif A, Fana M, Aboul Nour H, Zoghoul S, Eltous L, Miller D. Spinal procedures, pneumocephalus, and cranial nerve palsies: A review of the literature. Neuroradiol J 2024; 37:17-22. [PMID: 36628447 PMCID: PMC10863573 DOI: 10.1177/19714009221150851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Purpose: Minimally invasive and surgical spine procedures are commonplace with various risks and complications. Cranial nerve palsies, however, are infrequently encountered, particularly after procedures such as lumbar punctures, epidural anesthesia, or intrathecal injections, and are understandably worrisome for clinicians and patients as they may be interpreted as secondary to a sinister etiology. However, a less commonly considered source is a pneumocephalus which may, in rare cases, abut cranial nerves and cause a palsy as a benign and often self-resolving complication. Here, we present the case of a patient who underwent an intrathecal methotrexate infusion for newly diagnosed non-Hodgkin's T-cell lymphoma and subsequently developed an abducens nerve palsy due to pneumocephalus. We highlight the utility of various imaging modalities, treatment options, and review current literature on spinal procedures resulting in cranial nerve palsies attributable to pneumocephalus presenting as malignant etiologies.
Collapse
Affiliation(s)
- Ammar Jumah
- Department of Neurology, Henry Ford Hospital, Detroit, MI, USA
| | - Ali Alsaif
- Department of Neurology, Henry Ford Hospital, Detroit, MI, USA
| | - Michael Fana
- Department of Neurology, Henry Ford Hospital, Detroit, MI, USA
| | - Hassan Aboul Nour
- Department of Vascular Neurology, Emory University Hospital, Atlanta, GA, USA
| | - Sohaib Zoghoul
- Department of Radiology, Hamad Medical Corporation, Doha, Qatar
| | - Lara Eltous
- Jordan University of Science and Technology, Irbid, Jordan
| | - Daniel Miller
- Department of Neurology, Henry Ford Hospital, Detroit, MI, USA
| |
Collapse
|
4
|
Krez A, Malinzak M, Feeney C. Sudden-onset, non-traumatic large volume pneumocephalus following presentation of acute bacterial meningitis. BMJ Case Rep 2024; 17:e256194. [PMID: 38238161 PMCID: PMC10806969 DOI: 10.1136/bcr-2023-256194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2024] Open
Abstract
A man in his 30s, with sinonasal undifferentiated carcinoma status post resection 6 years prior, presented with acute onset of fever, headache and altered mentation. The patient was diagnosed with bacteremia and meningitis due to Streptococcus pneumoniae A standard antibiotic and corticosteroid regimen was started. Brain MRI showed an encephalocele abutting the superolateral nasopharynx mucosa. After several days of clinical improvement, the patient's mental status and headache acutely relapsed. A CT head venogram showed a large volume pneumocephalus originating from the region of a surgical defect. Management included external ventricular drain placement followed by right pterional craniotomy with skull base packing. Skull base defects increase the risk of life-threatening conditions such as bacterial meningitis and pneumocephalus. It is crucial for clinicians to be aware of the possibility of cranial surgical defects developing years after surgery.
Collapse
Affiliation(s)
- Alexandra Krez
- Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Michael Malinzak
- Department of Radiology, Duke University Hospital, Durham, North Carolina, USA
| | - Colby Feeney
- Departments of Medicine and Pediatrics, Duke University School of Medicine, Durham, North Carolina, USA
| |
Collapse
|
5
|
Hanalioglu D, Elbir C, Sahin OS, Ercandirli AK, Sahin B, Turkoglu ME, Kertmen HH, Hanalioglu S. Clinical Significance of Pneumocephalus in Pediatric Mild Traumatic Brain Injury. Pediatr Emerg Care 2023; 39:836-840. [PMID: 37815282 DOI: 10.1097/pec.0000000000003060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/11/2023]
Abstract
OBJECTIVES Mild traumatic brain injury (mTBI) comprises most (70%-90%) of all pediatric head trauma cases seeking emergency care. Although most mTBI cases have normal initial head computed tomography scan, a considerable portion of the cases have intracranial imaging abnormalities on computed tomography scan. Whereas other intracranial pathological findings have been extensively studied, little is known about the clinical significance of pneumocephalus in pediatric mTBI. METHODS We retrospectively identified pediatric mTBI patients with pneumocephalus using the institutional database of a large regional trauma referral center. Outcome measures were defined as clinically important TBI (ciTBI), hospitalization, intensive care unit (ICU) admission, and neurosurgical intervention. Comparisons were made between pneumocephalus and control (isolated linear fracture) groups as well as between isolated (only linear fracture and pneumocephalus) and nonisolated pneumocephalus (pneumocephalus and TBI) groups. RESULTS Among 3524 pediatric mTBI cases, 43 cases had pneumocephalus (1.2%). Twenty-one cases (48.8%) had isolated pneumocephalus. The pneumocephalus group had higher rates of ciTBI, hospital admission, ICU admission, and neurosurgery when compared with the isolated linear fracture (control) group. The isolated pneumocephalus group had fewer ciTBI (21.1% vs 70%, P = 0.002), fewer hospitalization (23.8% vs 81.8%, P < 0.001), but similar ICU admission rates (4.8% vs 22.7%, P = 0.089) and length of hospital stay (4.0 ± 2.7 vs 3.6 ± 2.4 days, P = 0.798) in comparison to the nonisolated pneumocephalus group. None of the patients in the isolated group had neurosurgery whereas 2 patients in the nonisolated pneumocephalus group underwent surgery. Multivariable analysis revealed pneumocephalus as an independent predictor of ciTBI and hospital admission, but not ICU admission or neurosurgical intervention. CONCLUSION Pneumocephalus is associated with increased rates of hospitalization and ciTBI, but not ICU admission, unfavorable outcome, or neurosurgical intervention in pediatric mTBI. Although usually spontaneously resolving pathology, it may occasionally be linked with complications such as cerebrospinal fluid leakage, meningitis, and tension pneumocephalus. Therefore, careful evaluation, close observation, and early detection of complications may prevent adverse outcomes.
Collapse
Affiliation(s)
| | - Cagri Elbir
- Department of Neurosurgery, University of Health Sciences, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - Omer Selcuk Sahin
- Department of Neurosurgery, University of Health Sciences, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - Aziz Kaan Ercandirli
- Department of Neurosurgery, University of Health Sciences, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - Balkan Sahin
- Department of Neurosurgery, University of Health Sciences, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Mehmet Erhan Turkoglu
- Department of Neurosurgery, University of Health Sciences, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - Huseyin Hayri Kertmen
- Department of Neurosurgery, University of Health Sciences, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | | |
Collapse
|
6
|
Jain C, Rewatkar A, Roy AK, Indira Devi B. Delayed Posttraumatic Tension Pneumocephalus: Case Report and Review of Literature. INDIAN JOURNAL OF NEUROTRAUMA 2023. [DOI: 10.1055/s-0043-1760726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
AbstractDelayed tension pneumocephalus is a rare entity. Twelve cases of posttraumatic delayed tension pneumocephalus have been reported. This study is a case report of a patient presenting with delayed posttraumatic tension pneumocephalus, and highlights the nuances of management.
Collapse
Affiliation(s)
- Chirag Jain
- Department of Neurosurgery, NIMHANS, Bangalore, India
| | | | | | | |
Collapse
|
7
|
Endoscopic Endonasal Skull Base Surgery Complication Avoidance: A Contemporary Review. Brain Sci 2022; 12:brainsci12121685. [PMID: 36552145 PMCID: PMC9776068 DOI: 10.3390/brainsci12121685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 12/03/2022] [Accepted: 12/05/2022] [Indexed: 12/13/2022] Open
Abstract
The endoscopic endonasal approach (EEA) provides a direct trajectory to ventral skull base lesions, avoidance of brain retraction, and clear visualization of cranial nerves as they exit skull base foramina. Despite these benefits, the EEA is not without complications. Here, we review published literature highlighting complications associated with the EEA including cerebrospinal fluid (CSF) leak, cranial nerve (CN) dysfunction, pituitary gland dysfunction, internal carotid artery (ICA) injury, infection, and others; we place special emphasis on discussing the prevention of these complications. As widespread adoption of the EEA continues, it becomes critical to educate surgeons regarding potential complications and their prevention while identifying gaps in the current literature to guide future research and advances in clinical care.
Collapse
|
8
|
Endoscopic Endonasal Eustachian Tube Obliteration as a Treatment for Tension Pneumocephalus After Translabyrinthine Resection of Vestibular Schwannoma. Otol Neurotol 2022; 43:e856-e860. [PMID: 35970161 DOI: 10.1097/mao.0000000000003606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Cerebrospinal fluid leak and pneumocephalus are rare but potentially devastating complications associated with translabyrinthine resection of cerebellopontine angle masses. Persistent pneumocephalus despite proximal eustachian tube (ET) obliteration is rare. We describe, to our knowledge, the first report of successful management of tension pneumocephalus by endoscopic endonasal ET obliteration using a novel V-loc (Covidien; Medtronic, Minneapolis, MN) suture technique. PATIENTS A 63-year-old man presented with altered mental status 10 months after translabyrinthine excision of a left cerebellopontine angle vestibular schwannoma measuring 2.8 × 2.9 × 3.3 cm. Computed tomography demonstrated diffuse ventriculomegaly and new pneumocephalus along the right frontal lobe, lateral ventricles, and third ventricle, and air within the left translabyrinthine resection cavity. INTERVENTION The patient underwent left-sided endoscopic endonasal ET obliteration using 2-0, 9-inch V-loc suture. MAIN OUTCOME MEASURE Postoperatively, the patient's mental status improved with a decrease in size of the lateral and third ventricles on computed tomography. CONCLUSION Endoscopic endonasal ET obliteration, a technique previously applied to recalcitrant cerebrospinal fluid leaks, is a safe and reasonable alternative to reentering the original surgical site for patients with pneumocephalus after lateral skull base surgery. Utilizing a V-loc suture for this technique instead of a traditional suture may improve procedural ease and speed.
Collapse
|
9
|
Alharbi A, Khairy S, Alkhani A. Pneumocephalus after subcutaneous emphysema. Surg Neurol Int 2022; 13:249. [PMID: 35855157 PMCID: PMC9282812 DOI: 10.25259/sni_994_2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 05/20/2022] [Indexed: 11/24/2022] Open
Abstract
Background: Pneumocephalus is the presence of air in the intracranial cavity secondary to communication with the extracranial compartment. It occurs spontaneously, after trauma, or after a cranial surgery. Case Description: A 62-year-old female, a known case of diabetes mellitus, presented to our emergency department with a sudden thunderclap headache. She was diagnosed with subarachnoid hemorrhage secondary to ruptured anterior communicating artery aneurysm. Twenty days later, she developed pneumonia and subsequently had a cardiac arrest. She was revived after 26 min of cardiopulmonary resuscitation. She developed pneumothorax requiring a chest tube insertion. After the first trial, she developed a diffuse subcutaneous emphysema, and the chest tube was reinserted. Afterward, she became unresponsive with dilated pupils. A computed tomography (CT) scan of the brain showed a diffuse subcutaneous emphysema reaching up to the face with air around the ventriculoperitoneal shunt distal catheter and extending through the burr hole to the ventricles causing pneumocephalus. There was no evidence of skull base fractures on brain CT. Unfortunately, the patient did not recover and passed away 3 days later. Conclusion: This report describes the presentation and radiological findings of an interesting case of pneumocephalus following iatrogenic diffuse subcutaneous emphysema. It aims to increase the emphasis on early anticipation of such rare complication after subcutaneous emphysema.
Collapse
Affiliation(s)
- Ahoud Alharbi
- Department of Surgery, Division of Neurosurgery, King Abdulaziz Medical City, Ministry of National Guard - Health Affairs, Riyadh, Saudi Arabia
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Sami Khairy
- Department of Surgery, Division of Neurosurgery, King Abdulaziz Medical City, Ministry of National Guard - Health Affairs, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Ahmed Alkhani
- Department of Surgery, Division of Neurosurgery, King Abdulaziz Medical City, Ministry of National Guard - Health Affairs, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| |
Collapse
|
10
|
Doron O, Schneider JR, Ellis JA. Application of the subdural evacuating port system for the drainage of postoperative tension pneumocephalus: A technical note. Surg Neurol Int 2022; 13:204. [PMID: 35673650 PMCID: PMC9168390 DOI: 10.25259/sni_120_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 04/16/2022] [Indexed: 11/20/2022] Open
Abstract
Background: Tension pneumocephalus is a neurosurgical emergency requiring prompt intervention. A variety of either temporizing or definitive methods was previously described as part of its management. Here, we report on an off-label use of a bed-side device and the subdural evacuating port system (SEPS)™ for the treatment of tension pneumocephalus. Methods: The SEPS™ (Medtronic Dublin, Ireland) is a minimally invasive tool that is indicated for the removal of chronic or subacute subdural hematomas and at the patient’s bedside. We describe the use of this system to evacuate tension pneumocephalus. Results: A 44-year-old patient operated in our institution was presented with sudden obtundation 4 days post resection of esthesioneuroblastoma. Imaging confirmed a significant tension pneumocephalus. Immediate bedside decompression using a SEPS bolt placed frontally was performed, achieving rapid evacuation and patient regained consciousness. A definitive skull base reconstruction was done at the operating room at a later stage. Conclusion: The SEPS™, well-known for evacuation of CSDH, can be potentially used as a bed-side tool to effectively treat mass effect created by tension pneumocephalus. As a readily-available and commercially used device, it can provide a simple and standard toolkit suitable for an emergent temporizing procedure.
Collapse
|
11
|
Maramattom BV. Quadriparesis Due to Delayed Tension Pneumoventricle. Neurologist 2021; 27:74-78. [PMID: 34842575 DOI: 10.1097/nrl.0000000000000363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Although pneumocephalus is very common after intracranial or spinal surgeries, pneumoventricle is uncommon. Tension pneumoventricle (tPV) occurs when air in the ventricles expands to cause neurological deficits or mass effect. It is usually seen with a combination of a ball-valve defect postoperatively that sucks in air and a ventriculoperitoneal shunt that drains cerebrospinal fluid and allows the ingress of air. CASE REPORT A young man developed delayed tPV after surgery for craniopharyngioma. He required multiple surgeries and occlusion of the ventriculoperitoneal shunt before the tPV resolved. CONCLUSIONS The probable mechanisms of tPV and the importance of early recognition and treatment are discussed. A review of the literature of this uncommon entity has also been performed.
Collapse
|
12
|
Barron KA, Mavrommatis MA, Kinberg EC, Iloreta A. Severe pneumocephalus following cranioplasty: Approach and review of the literature. OTOLARYNGOLOGY CASE REPORTS 2021. [DOI: 10.1016/j.xocr.2021.100364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
|
13
|
Praneeth K, Nachiappan DS, Gupta D. A Stitch in Time Saves Nine: Delayed Presentation of Tension Pneumocephalus as Stroke. Neurol India 2021; 69:1635-1636. [PMID: 34979661 DOI: 10.4103/0028-3886.333488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Kokkula Praneeth
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | | | - Deepak Gupta
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| |
Collapse
|
14
|
Kohl S, Köhler C, Kiefer I. MRI diagnosis of spontaneous intraventricular tension-pneumocephalus in a 10-month-old male Saarloos Wolfdog. Vet Radiol Ultrasound 2021; 63:e20-e23. [PMID: 34713527 DOI: 10.1111/vru.13040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 08/23/2021] [Accepted: 08/30/2021] [Indexed: 11/27/2022] Open
Abstract
A 10-month-old male Saarloos Wolfdog was presented with a history of multiple neurologic deficits that had acutely progressed. Neurologic examination findings localized signs to the cerebrum and brainstem. Magnetic resonance imaging revealed markedly enlarged and gas-filled lateral ventricles with a mass effect leading to cerebellar herniation. A right-sided defect of the cribriform plate with a dysplastic ethmoturbinate was identified as the inlet of air and origin of the intraventricular tension pneumocephalus. Surgical findings were consistent with a ruptured, congenital, nasal meningocele.
Collapse
Affiliation(s)
- Stefan Kohl
- Small Animal Clinic, Faculty of Veterinary Medicine, University of Leipzig, Leipzig, Germany
| | - Claudia Köhler
- Small Animal Clinic, Faculty of Veterinary Medicine, University of Leipzig, Leipzig, Germany
| | - Ingmar Kiefer
- Small Animal Clinic, Faculty of Veterinary Medicine, University of Leipzig, Leipzig, Germany
| |
Collapse
|
15
|
Mirkarimi T, Modirian E, Namdar P, Salek M. Delayed post-traumatic Tension Hydropneumocephalus; a Case Report of Conservative Treatment. ARCHIVES OF ACADEMIC EMERGENCY MEDICINE 2021. [PMID: 33870209 PMCID: PMC8039083 DOI: 10.22037/aaem.v9i1.1172] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Pneumocephalus refers to the presence of air in the cranial cavity. Trauma is the most common cause of acquired pneumocephalus. Tension pneumocephalus occurs when intracranial accumulation of air causes high pressure on the brain as compared to extracranial pressure. Tension pneumocephalus is usually acute, and causes neurological symptoms, and its delayed form rarely occurs. A 12-year-old girl presented with a headache, lethargy, mild fever, and nausea from two days before admission to emergency department of Shahid Rajaei Hospital, Qazvin, Iran. The patient had a history of head trauma in a driving accident six weeks before and had undergone brain computed tomography (CT) scan in another centre, which had revealed no sign of pneumocephalus. The patient had been treated for one week and had been discharged in good general condition. Considering her reduced consciousness, the patient underwent brain CT scan again in our centre. CT scan revealed tension hydropneumocephalus. The patient was transferred to the intensive care unit (ICU) for treatment. Considering the trend of her recovery, the patient was a candidate for conservative non-surgical therapy based on the in-charge neurosurgery specialist’s decision. The patient reported no complications during the six-month follow-up. Delayed tension pneumocephalus is among neurosurgery emergencies usually treated with early surgical intervention and dura defect restoration, but this patient received non-surgical treatment without any serious problem during the six-month follow-up.
Collapse
Affiliation(s)
- Talayeh Mirkarimi
- Emergency Department; Rajaei Hospital, Medical Faculty, Qazvin University of Medical Science, Qazvin, Iran
| | - Ehsan Modirian
- Emergency Department; Rajaei Hospital, Medical Faculty, Qazvin University of Medical Science, Qazvin, Iran
| | - Peyman Namdar
- Emergency Department; Rajaei Hospital, Medical Faculty, Qazvin University of Medical Science, Qazvin, Iran
| | - Mohammad Salek
- Emergency Department; Rajaei Hospital, Medical Faculty, Qazvin University of Medical Science, Qazvin, Iran
| |
Collapse
|
16
|
Wang W, Shokri T, Manolidis S, Ducic Y. Complications in Skull Base Surgery and Subsequent Repair. Semin Plast Surg 2020; 34:286-292. [PMID: 33380915 DOI: 10.1055/s-0040-1721765] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Over the past several decades, endoscopic sinus surgery has revolutionized the approach to skull base surgery. Open skull base approaches remain a viable option for advanced skull base tumors. Complications have gone down with increased reliability of vascularized tissue transfer. In this article, the authors explore the various complications that can present following skull base surgery and review the approaches for repair when such issues are encountered.
Collapse
Affiliation(s)
- Weitao Wang
- Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, Texas
| | - Tom Shokri
- Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, Texas
| | | | - Yadranko Ducic
- Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, Texas
| |
Collapse
|
17
|
Li W, Liu Q, Lu H, Wang H, Zhang H, Hu L, Sun X, Gu Y, Li H, Zhao W, Wang D. Tension Pneumocephalus from Endoscopic Endonasal Surgery: A Case Series and Literature Review. Ther Clin Risk Manag 2020; 16:531-538. [PMID: 32606712 PMCID: PMC7311094 DOI: 10.2147/tcrm.s258890] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 06/07/2020] [Indexed: 12/31/2022] Open
Abstract
Purpose Tension pneumocephalus (TP) caused by endoscopic endonasal surgery is a serious complication. We report four cases of TP caused by endoscopic surgery and review other cases in the literature, with special attention devoted to symptoms, imaging features, and therapeutic approaches. Methods A retrospective chart review of patients who experienced TP caused by endoscopic surgery in our institution between 2015 and 2018 was performed. Additionally, the MEDLINE database was searched for all case series or reports of TP caused by endoscopic surgery. Results Eighteen articles were identified for review, including four cases from the authors’ institution; ultimately, 26 cases were included in the present study. The main symptoms of TP were headache and a change in mental status. Cerebrospinal fluid (CSF) leakage was reported in 21 of the 26 patients (80.8%). Eight of the 26 patients (30.8%) presented with the “Mount Fuji sign” imaging feature. Twenty-four patients were treated with surgical intervention for TP (endoscopic multilayer closure of skull base defect, cranial burr hole, or bifrontal craniotomy). In addition, the present study is the first to report two patients with TP who were successfully treated conservatively. Conclusion The therapeutic method for treating TP should depend on the degree of the mass effect and clinical symptoms. When patients with TP present with obvious symptoms of CSF leakage and intracranial hypertension, urgent surgical multilayer repair of the skull base defects and/or release of the intracranial pressure are keys to treating these patients. However, conservative treatment under close observation is also feasible when the related symptoms are not overtly obvious.
Collapse
Affiliation(s)
- Wanpeng Li
- Department of Otolaryngology-Head and Neck Surgery, Affiliated Eye Ear Nose and Throat Hospital, Fudan University, Shanghai 200031, People's Republic of China
| | - Quan Liu
- Department of Otolaryngology-Head and Neck Surgery, Affiliated Eye Ear Nose and Throat Hospital, Fudan University, Shanghai 200031, People's Republic of China
| | - Hanyu Lu
- Department of Otolaryngology-Head and Neck Surgery, Affiliated Eye Ear Nose and Throat Hospital, Fudan University, Shanghai 200031, People's Republic of China
| | - Huan Wang
- Department of Otolaryngology-Head and Neck Surgery, Affiliated Eye Ear Nose and Throat Hospital, Fudan University, Shanghai 200031, People's Republic of China
| | - Huankang Zhang
- Department of Otolaryngology-Head and Neck Surgery, Affiliated Eye Ear Nose and Throat Hospital, Fudan University, Shanghai 200031, People's Republic of China
| | - Li Hu
- Department of Otolaryngology-Head and Neck Surgery, Affiliated Eye Ear Nose and Throat Hospital, Fudan University, Shanghai 200031, People's Republic of China
| | - Xicai Sun
- Department of Otolaryngology-Head and Neck Surgery, Affiliated Eye Ear Nose and Throat Hospital, Fudan University, Shanghai 200031, People's Republic of China
| | - Yurong Gu
- Department of Otolaryngology-Head and Neck Surgery, Affiliated Eye Ear Nose and Throat Hospital, Fudan University, Shanghai 200031, People's Republic of China
| | - Houyong Li
- Department of Otolaryngology-Head and Neck Surgery, Affiliated Eye Ear Nose and Throat Hospital, Fudan University, Shanghai 200031, People's Republic of China
| | - Weidong Zhao
- Department of Otolaryngology-Head and Neck Surgery, Affiliated Eye Ear Nose and Throat Hospital, Fudan University, Shanghai 200031, People's Republic of China
| | - Dehui Wang
- Department of Otolaryngology-Head and Neck Surgery, Affiliated Eye Ear Nose and Throat Hospital, Fudan University, Shanghai 200031, People's Republic of China
| |
Collapse
|
18
|
Significance of intracranial gas on post-mortem computed tomography in traumatic cases in the context of medico-legal opinions. Forensic Sci Med Pathol 2020; 16:3-11. [PMID: 31463781 PMCID: PMC7069893 DOI: 10.1007/s12024-019-00162-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/13/2019] [Indexed: 11/24/2022]
Abstract
The detection of intracranial gas (ICG) in people who died due to trauma became possible once postmortem computed tomography (PMCT) became available in addition to traditional post-mortem examinations. The aim of this study was to determine the importance of ICG in the context of medico-legal opinions. We assessed 159 cases of trauma-induced death. Cadavers with pronounced signs of decomposition, open skull fractures, and after neurosurgical operations were excluded. Both PMCT findings and data from autopsy reports were analyzed. ICG was found in 38.99% (n = 62) of the cadavers, 96.77% (n = 60) of which presented with pneumocephalus (PNC) and 40.23% (n = 25) with intravascular gas (IVG). There was a strong correlation between ICG and skull fractures/brain injuries, as well as chest injuries, especially lung injuries. In 13 cases, ICG presented without skull fractures; three of these cases died as a result of stab and incised wounds to the neck and chest. The mean time between trauma and death was significantly longer in the non-ICG group than the ICG group at 2.94 days (0–48 days) and 0.01 day (0–1 day), respectively (p < 0.0001). The presence of ICG is a result of severe neck and chest injuries, including stab and incised wounds. The victims die in a very short amount of time after suffering trauma resulting in ICG. The ability to demonstrate ICG on PMCT scans can be of significance in forming medico-legal opinions.
Collapse
|
19
|
Pneumocephalus: a rare and life-threatening, but reversible, complication after penetrating lumbar injury. Acta Neurochir (Wien) 2019; 161:361-365. [PMID: 30652201 PMCID: PMC6373275 DOI: 10.1007/s00701-018-03796-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 12/31/2018] [Indexed: 11/05/2022]
Abstract
Pneumocephalus, the presence of intracranial air, is a complication especially seen after neurotrauma or brain surgery. When it leads to a pressure gradient, a so-called tension pneumocephalus, it may require emergency surgery. Clinical symptomatology, especially in young children, does not differentiate between a pneumocephalus and a tension pneumocephalus. An additional CT scan is therefore warranted. Here, we report on a rare case of pneumocephalus after penetrating lumbar injury. Additionally, the pathophysiology of pneumocephalus, as well as its recommendations for diagnosis and treatment, will be elucidated.
Collapse
|
20
|
Rasouli M, Honeybul S. Delayed tension pneumocephalus following decompressive craniectomy. J Clin Neurosci 2018; 58:205-206. [PMID: 30297142 DOI: 10.1016/j.jocn.2018.09.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2018] [Revised: 08/04/2018] [Accepted: 09/24/2018] [Indexed: 10/28/2022]
Abstract
Pneumocephalus is defined as a collection of air in the cranial cavity and is a common finding following intracranial neurosurgical procedures or following skull base fractures. The term tension pneumocephalus describes the accumulation of air under pressure such that it exerts mass effect and leads to a neurological deterioration. Whilst this is a rare event it can be life threatening and requires prompt intervention. We describe a case that occurred in a delayed fashion following a decompressive craniectomy for a severe traumatic brain injury. It was initially treated by urgent aspiration at a peripheral hospital under neurosurgical guidance.
Collapse
Affiliation(s)
- Mohammad Rasouli
- Department of Neurosurgery, Sir Charles Gairdner Hospital, Nedlands, Western Australia 6009, Australia.
| | - Stephen Honeybul
- Department of Neurosurgery, Sir Charles Gairdner Hospital, Nedlands, Western Australia 6009, Australia; Royal Perth Hospital, Wellington Street, Perth, Western Australia 6000, Australia
| |
Collapse
|
21
|
Successful Treatment of Pneumocephalus Using a Free-Style Chimeric Free Flap From a Scarred Thigh. J Craniofac Surg 2018; 29:e658-e660. [DOI: 10.1097/scs.0000000000004715] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
|
22
|
Abstract
OBJECTIVES We aimed to determine the prevalence of and adverse outcomes caused by pneumocephali in children with minor blunt head trauma who had no other intracranial injuries (ie, isolated pneumocephali). METHODS We conducted a secondary analysis of a public use dataset from a multicenter prospective study of pediatric minor head trauma. We included children younger than 18 years with Glasgow Coma Scale (GCS) scores of 14 or 15 and non-trivial mechanisms of injury who had cranial computed tomographies obtained. Patients with isolated pneumocephali were those without other traumatic brain injuries (TBIs) but could have non-depressed or basilar skull fractures (BSFs). We defined adverse outcomes as death, need for neurosurgery, or intubation more than 24 hours for TBI. RESULTS Pneumocephali occurred in 148 (1.0%; 95% confidence interval, 0.8%-1.2%) of 14,983 patients; 54 (36.5%) of 148 were isolated. Of these 54 patients, 42 (77.8%) had associated BSFs (7 of whom also had linear skull fractures) and 8 (14.8%) had associated linear skull fractures without BSFs; 4 patients (7.4%) had no fractures. Thirty-three patients (61.1%) had both GCS scores of 15 and no other signs of altered mental status. All patients with isolated pneumocephali and available descriptive data (n = 26) had small-sized pneumocephali. There were no deaths, neurosurgical interventions, or intubations for more than 24 hours for TBI (95% confidence interval for any of the outcomes, 0%-7.9%) in the 54 patients with isolated pneumocephali. CONCLUSIONS Children with isolated pneumocephali and GCS scores of 14 or 15 after minor blunt head trauma are unlikely to have adverse clinical outcomes.
Collapse
|
23
|
Baradaranfar M, Vaziribozorg S, Mirzade M, Salari M. Pneumocephalus after Tympanomastoidectomy: A Case Presentation. IRANIAN JOURNAL OF OTORHINOLARYNGOLOGY 2018; 30:177-180. [PMID: 29876334 PMCID: PMC5985621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Pneumocephalus is the presence of air or gas within the cranial cavity. It can occur following otorhinolaryngological procedures. A small pneumocephalus spontaneously heals without any treatment. In severe cases, conservative therapy includes a 30-degree head elevation, avoidance of the Valsalva maneuver, analgesics, osmotic diuretics, and oxygen therapy. CASE REPORT A 56-year-old woman was referred to the emergency department due to a severe headache in the frontal area for 2 days before admission. The patient experienced nausea and vomiting in the morning and had no history of seizures or decreased consciousness. Examination of neurological symptoms was completely normal and showed no symptoms of meningeal irritation. In terms of past history, the patient had undergone tympanomastoidectomy surgery and resection of the cholesteatoma 1 week previously. The Mount Fuji sign was found on the brain computed tomography (CT) scan of the patient. Treatments such as CBR (complete bed rest), 30-degree head elevation, anti-fever, analgesics and oxygen therapy, along with anti-compulsive drug (phenytoin), were prescribed. At the end of 5 days, the patient's pneumocephalus was resolved completely. CONCLUSION Pneumocephalus should be considered a post-operative complication of tympanomastoidectomy. In most cases, pneumocephalus responds to conservative therapy. Supplemental oxygen increases the rate of absorption of pneumocephalus. Serial imaging is needed to ensure gradual reduction of the pneumocephalus.
Collapse
Affiliation(s)
- Mohammadhossein Baradaranfar
- Department of Otolaryngology- Head and Neck Surgery, Otorhinolaryngology Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
| | - Sedighe Vaziribozorg
- Department of Otolaryngology- Head and Neck Surgery, Otorhinolaryngology Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
| | - Mojtaba Mirzade
- Department of Otolaryngology- Head and Neck Surgery, Otorhinolaryngology Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.,Corresponding Author: Department of Otolaryngology- Head and Neck Surgery, Otorhinolaryngology Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran. Tel: 00983538224000, E-mail:
| | - Mostafa Salari
- Faculty of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
| |
Collapse
|
24
|
Sachkova A, Schemmerling T, Goldberg M, Solomiichuk V, Rohde V, von Eckardstein KL, Schatlo B. Predictors of ventricular tension pneumocephalus after posterior fossa surgery in the sitting position. Acta Neurochir (Wien) 2018; 160:525-538. [PMID: 29307024 DOI: 10.1007/s00701-017-3444-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 12/21/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Ventricular pneumocephalus is a rare but potentially life-threatening complication of cranial surgery in the sitting position. OBJECTIVE The objective of the study is to assess the incidence and risk factors of postoperative ventricular pneumocephalus. METHODS We performed a retrospective chart review of 307 consecutive patients (147 men, 160 women) treated at our institution by intracranial surgery in the sitting position from January 2010 to October 2014. Ventricular air entrapment with lack of arousal or neurologic deterioration requiring external ventriculostomy (EVD) was defined as ventricular tension pneumocephalus (VTP). Demographic variables were recorded along with radiological and clinical data. The occurrence of pneumocephalus was correlated with patient-related and surgical variables. RESULTS VTP was observed in 12 cases (3.9%). These patients had higher intraventricular air volumes (48.5 cm3 (CI 95% [29.06-67.86])) compared to asymptomatic patients (7.4 cm3 (CI 95% [5.43-9.48])). Opening of the fourth ventricle was the most potent predictor of VTP (OR = 34.7, CI 95% [4.4-273.5], p = 0.001). In patients undergoing no additional treatment for pneumocephalus, ventricular air volume declined to an average of 41.7% of the initial postoperative volume on postoperative day 3. CONCLUSIONS Entrapment of intracranial and particularly ventricular air requiring emergent EVD occurred in 3.9% cases of intracranial surgery in the sitting position. Especially the opening of the fourth ventricle was associated with the development of VTP, which should warrant particularly diligent postoperative observation of these patients. In cases without neurological symptoms, the rate of spontaneous air resorption is sufficiently high to warrant expectant management.
Collapse
|
25
|
Pneumocephalus Following Self-Inflicted Penetrating Brain Injury. Case Rep Otolaryngol 2018; 2017:7878646. [PMID: 29312790 PMCID: PMC5634588 DOI: 10.1155/2017/7878646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2017] [Revised: 08/10/2017] [Accepted: 08/20/2017] [Indexed: 12/03/2022] Open
Abstract
Objective Pneumocephalus is a rare complication that often occurs after traumatic skull base injury, leading to morbidity and mortality. Material and Method We present the case of a 42-year-old healthy man who injured himself when he stuck a metal stick into his left nasal cavity to relieve prolonged nasal obstruction. Immediate cerebrospinal fluid rhinorrhea and subsequent meningitis and pneumocephalus occurred later. He was presented at our hospital with fever and meningeal signs. Result Computed tomography scans revealed left rhinosinusitis and air collection in the subarachnoid space. The patient received the conservative treatment of bed rest, intravenous hydration, head elevation, and broad-spectrum intravenous antibiotics. Pneumocephalus and meningitis resolved without any surgery, and he experienced no other sequela or complication. Conclusion Pneumocephalus is a rare incidence and can lead to high morbidity and mortality. Prompt diagnosis and adequate treatment of pneumocephalus and meningitis proved beneficial for our patient who recovered without any complication or surgery.
Collapse
|
26
|
Al-Aieb A, Peralta R, Ellabib M, El-Menyar A, Al-Thani H. Traumatic tension pneumocephalus: Two case reports. Int J Surg Case Rep 2017; 31:145-149. [PMID: 28152490 PMCID: PMC5288330 DOI: 10.1016/j.ijscr.2017.01.038] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Revised: 01/16/2017] [Accepted: 01/16/2017] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Traumatic pneumocephalus rarely evolves into tension pneumocephalus. It can be devastating if not recognized and treated promptly. CASE PRESENTATION We presented two cases of post-traumatic tension pneumocephalus. A 30- year old male pedestrian hit by a car presented with right frontal bone fracture extending to right frontal sinuses. He developed pneumocephalus involving all ventricles and subdural space and extending down to foramen magnum with tight basal cistern. The patient was managed conservatively. During the hospital course, he developed cerebrospinal fluid leak from the facial fractures and meningitis. After complete recovery, the patient was discharged home in a good health condition. The second case was a 43- year old lady driver who involved in a motor vehicle crash and presented with comminuted fracture of the right frontal bone, right parietal extra-axial hemorrhage. She developed pnemocephalus involving the bilateral frontal lobes, mainly on the left side with extension to the left lateral ventricle. Pneumocephalus was also noted in the pre-pontine cistern. The patient had rhinorrhea during the hospital course. The patient underwent wound debridement, intracranial pressure monitoring, and repair of her globe and advancement flap for right facial injury. CONCLUSIONS These are two rare cases with posttraumatic tension pneumocephalus treated conservatively with a favorable outcome. Early diagnosis of tension pneumocephalus is a crucial step to facilitate early recovery; however, the associated injuries need attention as they could influence the hospital course.
Collapse
Affiliation(s)
- Abubaker Al-Aieb
- Department of Surgery, Trauma Surgery, Hamad General Hospital, Doha, Qatar
| | - Ruben Peralta
- Department of Surgery, Trauma Surgery, Hamad General Hospital, Doha, Qatar
| | - Mohammad Ellabib
- Department of Surgery, Trauma Surgery, Hamad General Hospital, Doha, Qatar
| | - Ayman El-Menyar
- Department of Surgery, Trauma Surgery, Clinical Research, Hamad General Hospital, Doha, Qatar; Clinical Medicine, Weill Cornell Medical College, Doha, Qatar.
| | - Hassan Al-Thani
- Department of Surgery, Trauma Surgery, Hamad General Hospital, Doha, Qatar
| |
Collapse
|
27
|
Delayed Tension Pneumocephalus following Gunshot Wound to the Head: A Case Report and Review of the Literature. Case Rep Surg 2017; 2016:7534571. [PMID: 28074167 PMCID: PMC5198091 DOI: 10.1155/2016/7534571] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Accepted: 11/20/2016] [Indexed: 11/18/2022] Open
Abstract
Tension pneumocephalus is a rare complication of head trauma and neurosurgical procedures, amongst other causes. It is defined by the combination of intracranial air, increased intracranial pressure, and mass effect. Although it often presents soon after surgery, it can also rarely present in a delayed fashion. We present a case of delayed tension pneumocephalus, occurring approximately 16 weeks after bifrontal craniectomy for a self-inflicted gunshot wound. Following a month of rhinorrhea, postnasal drip, and cough, the patient presented with a sensation of expansion in the area of the right forehead. As tension pneumocephalus is an emergency that can be fatal, this patient was treated expediently and avoided severe neurological deficits. The case recounted here is important as a demonstrative example that tension pneumocephalus does not always follow a defined course immediately after trauma or neurosurgery but rather can develop insidiously without obvious signs.
Collapse
|
28
|
Dabdoub CB, Salas G, Silveira EDN, Dabdoub CF. Review of the management of pneumocephalus. Surg Neurol Int 2015; 6:155. [PMID: 26500801 PMCID: PMC4596054 DOI: 10.4103/2152-7806.166195] [Citation(s) in RCA: 78] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2015] [Accepted: 07/09/2015] [Indexed: 12/28/2022] Open
Abstract
Background: Pneumocephalus (PNC) is the presence of air in the intracranial cavity. The most frequent cause is trauma, but there are many other etiological factors, such as surgical procedures. PNC with compression of frontal lobes and the widening of the interhemispheric space between the tips of the frontal lobes is a characteristic radiological finding of the “Mount Fuji sign.” In addition to presenting our own case, we reviewed the most relevant clinical features, diagnostic methods, and conservative management for this condition. Case Description: A 74-year-old male was diagnosed with meningioma of olfactory groove several years ago. After no improvement, surgery of the left frontal craniotomy keyhole type was conducted. A computed tomography (CT) scan of the skull performed 24 h later showed a neuroimaging that it is described as the silhouette of Mount Fuji. The treatment was conservative and used continuous oxygen for 5 days. Control CT scan demonstrated reduction of the intracranial air with normal brain parenchyma. Conclusion: The review of the literature, we did not find any cases of tension pneumocephalus documented previously through a supraorbital keyhole approach. There are a few cases reported of patients with Mount Fuji signs that do not require surgical procedures. The conservative treatment in our report leads to clinical and radiological improvement as well as a reduction in hospitalization time.
Collapse
Affiliation(s)
- Carlos B Dabdoub
- Department of Neurosurgery, Campo Limpo Municipal Hospital, São Paulo, Brasil
| | - Gueider Salas
- Department of Neurosurgery, Caja Petrolera de Salud Hospital, Santa Cruz de la Sierra, Bolivia
| | | | - Carlos F Dabdoub
- Department of Neurosurgery, School of Medicine, Franz Tamayo University, Santa Cruz de la Sierra, Bolivia
| |
Collapse
|
29
|
Aksoy F, Dogan R, Ozturan O, Tuğrul S, Yıldırım YS. Tension pneumocephalus: an extremely small defect leading to an extremely serious problem. Am J Otolaryngol 2013; 34:749-52. [PMID: 24035614 DOI: 10.1016/j.amjoto.2013.07.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2013] [Revised: 07/15/2013] [Accepted: 07/22/2013] [Indexed: 11/18/2022]
Abstract
BACKGROUND Pneumocephalus is a pathology characterized by air influx into the intracranial region. It may occur after head trauma and rarely after endoscopic sinus surgery. As the amount of air increases, this can cause neurological disorders with a mass effect and this condition is called tension pneumocephalus. CASE DESCRIPTION Our case is a 65-year-old woman. Tension pneumocephalus developed 12h after endoscopic sinus surgery performed for nasal polypectomy. Since tension pneumocephalus developed very rapidly in the patient creating a herniation table, the patient was taken to theater immediately. A burr-hole was drilled into the skull and a small defect in the ethmoid roof was closed with a layered closure technique. Post-operative conservative treatment was applied (bed rest, raising the bed head, meningitis prophylaxis, loop diuretics, abstaining from maneuvers increasing the Valsalva). DISCUSSION In the literature, it is stated that, in the case of a small defect, spontaneous resolution may be provided with conservative treatment, but as the size of the defect increases, neurological effects will occur more quickly and be more obvious. In our case, a herniation table developed leading to neurological and vital problems in a more rapid and more obvious way than in other tension pneumocephalus cases developing after endoscopic sinus surgery. We consider that this situation is related to a very small defect size. CONCLUSION Tension pneumocephalus is a complication rarely seen after endoscopic sinus surgery, but if it is not treated immediately, it may give rise to serious morbidity and mortality concerns. The clinical course developing after tension pneumocephalus may be very serious when very small defects are involved.
Collapse
Affiliation(s)
- Fadlullah Aksoy
- Department of Otorhinolaryngology, Bezmialem Vakif University, Fatih, Istanbul, Turkey
| | | | | | | | | |
Collapse
|